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Sunday, August 8, 2010  
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Care Solution Corner
Susan J. Gromacki, OD, MS, FAAO
One interesting element regarding the Fusarium and Acanthamoeba keratitis outbreaks among contact lens wearers is that the United States Food and Drug Administration (FDA) does not require regulatory testing of contact lens disinfecting solutions for efficacy against Acanthamoeba. The required panel of microorganisms currently includes five microbial strains from the American Type Culture Collection: 1. Pseudomonas aeruginosa
2. Serratia marcescens
3. Staphylococcus aureus
4. Fusarium solani
5. Candida albicans

In addition, while only one strain of Fusarium is required for testing, at least 19 different phenotypes were responsible for the outbreak a few years ago. It is, of course, important to test for standardized strains such as these. Since the outbreaks, however, the FDA's Ophthalmic Devices Panel recommended that the FDA include additional clinical isolates—actual strains isolated from patients with confirmed keratitis -- in its testing regimens. What will the FDA do next? We don't know yet, but stay tuned. Contact Lenses Today will keep you posted.

CLToday Quick Poll
Last Week's Results
New and innovative technology in which of the following areas would lead to the largest growth in the contact lens portion of your practice?



 Daily disposables

 More comfortable contact lens materials

Ocular Surface Update
Kelly K. Nichols, OD, MPH, PhD, FAAO

The field of ocular surface research and clinical care in this area are expanding at an exponential pace, yet, it is important that we not forget about the impact on the care of the contact lens patient. I recently heard a comment from an industry representative that the contact lens dry eye market is relatively small. I am still thinking about that comment...relative to what? The overall dry eye market? The ocular therapeutic market?

Numerically speaking, there are about 35 million contact lens wearers in the United States, and depending on your definition, it could be that up to one-half of them have dry eye (e.g., symptoms, tear instability). While there may be 20-30+ million Americans with dry eye and/or blepharitis (non-contact lens related), the overlap between the lens wearers and non-lens wearers may be significant—and this is very important from a management perspective.

Discussing ocular surface disease in the context with this forum is valuable as it allows for an opportunity to remind eyecare practitioners of all management options, including medically oriented patient care, as the care of a these two patient groups does not have to be distinct.


AOA Awards 1•Day Acuvue TruEye Seal of Acceptance for UV Absorbing Contact Lenses

1•Day Acuvue TruEye brand contact lenses became the fifth contact lens in the Acuvue family of products to receive the Seal of Acceptance for Ultraviolet Absorbing Contact Lenses from the American Optometric Association's (AOA) Commission on Ophthalmic Standards.

In awarding the Seal of Acceptance, the AOA's Commission on Ophthalmic Standards, which provides independent evaluation of ophthalmic related products, determined that 1•Day Acuvue TruEye meets AOA specifications for ultraviolet absorbing contact lenses. These specifications are in accordance with published standards of the American National Standards Institute (ANSI) and International Standards Organization (ISO).

"Although UV-blocking contact lenses provide important added protection for patients, they should not be viewed as a stand-alone solution," notes Karl M. Citek, OD, PhD, Chair of the Commission on Ophthalmic Standards. "Contact lenses should always be worn in conjunction with high-quality UV-blocking sunglasses and a wide-brimmed hat for maximum UV protection for the eyes."


Preserving Independent Optometry Program Offered in Florida

Primary Eyecare Network (PEN), the practice development division of ABB CONCISE, will present one of its Preserving Independent Optometry (PIO) programs outside of California for the first time. Focused on achieving practice excellence by improving financials, staffing and marketing, PIO 2010 will take place at the Harbor Beach Marriott Resort & Spa in Ft. Lauderdale, Florida on October 23-24, 2010.

PIO 2010, an MBA Program sponsored by CIBA Vision and Essilor Laboratories, will present proven strategies and tactics designed to improve the financial success of the optometric practice and at the same time enhance patient satisfaction. The Management & Business Academy (MBA) for Eye Care Professionals is a specialized education program designed to teach private practice ODs advanced business strategies and techniques to improve practice performance. Now in its sixth year, MBA has won the endorsement of the American Optometric Association. The seminar features prominent practice management experts.

To register or request program information, please call PEN at 800-444-9230 or visit PEN's website at www.PrimaryEye.net.

Marietta Vision Introduces Bio Contact Lens

Marietta Vision recently announced the launch of the new Bio contact lens. The company refers to Bio contact lenses as a "more natural alternative" in that the Bio lens is made with a biocompatible contact lens material, Hioxifilcon/GMA. Even the box and package is made with recycled paper and is biodegradable.

"The American consumer is looking for green alternatives in all types of products. With the Bio contact lens, there is now a green alternative in contact lens wear," said John M. Patterson, President of Marietta Vision.

According to the company, the biocompatibility of the Bio lens is achieved through synthesizing the compatibility properties of mucin, the body's natural wetting substance. The lens has water binding properties that enhance resistance to dehydration and increase lens surface wettability providing a greater affinity for water. Wearers benefit from longer, more comfortable wearing times providing them with a truly comfortable "all day" lens.

The Bio lens has been enhanced with aberration correcting aspheric optics which incorporate innovative wavefront design and technology on the front surface of the lens. Patients who normally require low amounts of toric correction can benefit from the lens as the aspheric optical design can successfully mask low levels of astigmatism.

Packaged in convenient 6-packs, the Bio lens is available in an 8.5mm base curve in powers from -12.00 to +6.00 (in .50D steps above -6.00). The lens is only available though eyecare practitioners. For more information, visit www.MariettaVision.com.

This month at www.siliconehydrogels.org: fitting silicone hydrogels for patients with sub-optimal endothelial cell function, tear exchange rate with silicone hydrogel lenses, and our synopsis of silicone hydrogels at the 2009 AAO meeting.
Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO
I am often amazed when I hear doctors discussing hesitancy about fitting specialty contact lenses. I believe that there is a misconception about both the perceived difficulty and the perceived increased chair time in fitting these contact lens options. I strongly urge you to reconsider these perceptions. There are many ways you can get started fitting specialty lenses. Our August issue of Contact Lens Spectrum is at press as this is written. Look for an excellent article by Drs. Tom Quinn, LaMar Zigler, and Keith Ames on "Building a Specialty Contact Lens Practice."
Reader Commentary

I appreciated your commentary encouraging doctors to look closely at the science behind the marketing of products. Studies are often supported by for-profit companies who look to support their marketing efforts. This is especially true when it comes to nutritional supplements, and even more so for eyecare products. There are literally thousands of eye-health based nutritional products available for and marketed to the practitioner. I always urge attendees of my presentations to "question the science" when reviewing potential products to recommend to patients. We need to be critical of this science, not because it may be based on flawed studies, but because the title and abstract of a study might not always be free of bias. Therefore, it is more important than ever that the eyecare professional read the full study and draw their own conclusions, or find a nutritional expert who they trust to do so. There is valid science behind nutritional support for eye health and we owe it to our patients to be well informed.

Jeffrey Anshel, OD, FAAO
President, Ocular Nutrition Society


Traumatic Dislocation of LASIK Flaps 4 and 9 Years After Surgery
This is a report on two patients who developed a corneal flap dehiscence 4 years and 9 years after LASIK, respectively, following trauma during routine domestic activities.

A review of published cases in the English literature on late onset flap dislocation was performed. Clinical presentation, mechanism of injury, treatment, complications, and outcome were studied.

Case 1 involved a 30-year-old man who presented 4 years after LASIK, after his eye was struck with a piece of wood from a window trim. Examination showed uncorrected visual acuity (UCVA) of 20/25 and flap displacement, creating a fold at the superior edge. Because the injury involved the periphery of the flap, the patient was treated medically only. Final UCVA was 20/20(-1) with a persistent fold.

Case 2 involved a 29-year-old man who dislocated his flap after being hit with a dog's paw 9 years after LASIK. Uncorrected visual acuity was count fingers, and a complete flap dislocation that was folded at the hinge with 30% epithelial ingrowth was noted. Immediate surgical removal of the epithelium from the stromal bed was completed and a bandage contact lens was used along with topical medication. Final UCVA was 20/25, with no complications.

The authors concluded that flap dehiscence is a rare, late complication of LASIK. Case 1 is the second report of flap dislocation treated medically only and case 2 is the latest report. Tangential force applied to the flap during routine activities of life can result in flap displacement for up to 9 years after LASIK.

Kim HJ, Silverman CM. Traumatic dislocation of LASIK flaps 4 and 9 years after surgery. J Refract Surg 2010;26(6):447-52.

Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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